Objective: To investigate the effectiveness of the combination of the anterolateral thigh perforator (ALTP) flap and other flaps for repairing the extreme circumferential defects on the limb.
Methods: Between October 2016 and June 2019, 9 patients with the extreme circumferential defects on the limb were admitted, which resulted by degloving injury, including 8 males and 1 female with a median age of 42 years (range, 32-65 years). The etiology involved twist injury in 5 cases, traffic accident in 2 cases, and high voltage electric injury in 2 cases. The location of the defects was left forearm in 2 cases, right forearm in 3, left foot in 3, and right foot in 1. The injected wound bed followed by the exposure of bone, joint, tendon, and blood vessel. The dimension of defects was 25 cm×20 cm to 40 cm×28 cm. The period between the injury and admission was 1-12 hours (mean, 5 hours). All contaminated wounds were taken thorough and radical debridement and covered by the vacuum sealing drainage device during the emergency operation. The ALTP flap and the other one flap were tailored according to the dimension of the wound when the wound surface became granulating, including the thoracodorsal artery perforator (TAP) flap in 3 cases, superficial inferior epigastric artery perforator flap in 3 cases, superficial circumflex iliac artery perforator flap in 3 cases. And the donor site was primary closure.
Results: After operation, all the flaps survived except 1 case of partial necrosis at the edge of TAP flap and healed after secondary skin grafting, and the wounds in the donor and recipient areas healed by first intention. All patients were followed up 14-24 months (mean, 16 months). The shape of the flap was satisfactory and the texture was soft. There was no abnormal hair growth and obvious pigmentation during the follow-up. Only linear scar was left in the donor area, there was no complication such as abdominal wall hernia, and the activity of hip and knee was not affected. The functional reconstruction of upper limb and ankle was satisfactory, and the disabilities of the arm, shoulder, and hand (DASH) score was excellent in 4 cases and good in 1 case; the American Orthopaedic Foot and Ankle Association (AOFAS) score was excellent in 3 cases and good in 1 case.
Conclusion: ALTP flap combined with different flaps can reconstruct the circumferential extreme defects after limb damage in one-stage, which can achieve limb salvage to the greatest extent.
目的: 探讨组合股前外侧穿支（anterolateral thigh perforator，ALTP）皮瓣与不同皮瓣瓦合修复肢体大面积环形缺损的临床疗效。.
方法: 2016年10月—2019年6月收治脱套伤致肢体大面积环形缺损患者9例，其中男8例，女1例；年龄32～65岁，中位年龄42岁。致伤原因：机器绞伤5例，交通事故伤2例，高压电击伤2例。创面部位：左前臂2例，右前臂3例，左足3例，右足1例。创面污染严重，均伴有不同程度的血管、肌腱及骨、关节外露。缺损范围为25 cm×20 cm～40 cm×28 cm。受伤至入院时间1～12 h，平均5 h。急诊予以彻底清创及创面封闭式负压引流，待创面肉芽组织生长红润后，根据创面特征制备形状及大小匹配的ALTP皮瓣与另一皮瓣瓦合修复缺损，瓦合皮瓣包括3例胸背动脉穿支（thoracodorsal artery perforator，TAP）皮瓣，3例腹壁浅动脉穿支皮瓣，3例旋髂浅动脉穿支皮瓣。供区直接一期闭合。.
结果: 术后除1例组合中的TAP皮瓣边缘部分坏死，经二期植皮后愈合，其余皮瓣全部成活，供受区创面均Ⅰ期愈合。患者均获随访，随访时间14～24个月，平均16个月。皮瓣外形满意，质地柔软，随访期间未出现异常毛发生长、明显色素沉着。供区仅遗留线性瘢痕，未出现腹壁疝等并发症，髋、膝关节活动未受影响。上肢及足踝功能重建满意，上肢功能残障评定表（DASH）评分达优4例、良1例；美国矫形足踝协会（AOFAS）评分达优3例、良1例。.
结论: ALTP皮瓣与不同皮瓣瓦合一期修复肢体毁损伤后环形缺损，能最大程度实现保肢治疗。.
Keywords: Anterolateral thigh perforator flap; circumferential defect; combined transplantation; degloving injury.